Examining Relational Dimensions of Service Encounters for Disadvantaged People Who Use Drugs

Disadvantaged groups in general, and people who use illicit drugs in particular, have consistently been found to mistrust welfare services and service providers. Therefore, knowledge is needed on the relational aspects of service design that facilitate engagement and supportive relationships with disadvantaged consumers.

We draw on qualitative interviews investigating the experiences of adults with histories of problematic drug use participating in a health justice partnership, to identify facilitators of engagement from the perspective of the consumers.

Common relational facilitators of engagement were identified. These included embedding the service into the local community, foregrounding proximity and relationships in the service encounters, giving consumers' agency, priorities, and concerns primacy over program aims, and safe services acting as gateways to accessing a wider range of resources, services, and programs.

The findings suggest that the centrality of relationships may be further heightened in services seeking to assist people in positions of severe disadvantage, including the drug and alcohol arena. In addition, the findings highlight the importance of services paying greater attention to how social and community embeddedness shapes experiences of inclusion and exclusion and designing services best able to accommodate this. This research contributes to the broader understanding of consumer engagement with services by developing a more nuanced understanding of consumer refusal and resistance to service engagement. These findings are important in the development of justice programs for disadvantaged people and people who use illicit substances specifically.